Influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness

Abstract

Objective To analyze the influencing factors for tracheostomy decannulation in patients with prolonged disorders of consciousness. Methods Clinical data of 59 cases with prolonged disorders of consciousness and having undergone tracheotomy in Guangdong Provincial Work Injury Rehabilitation Hospital from January 2019 to October 2020 were collected and retrospectively analyzed in this study. The patients were divided into extubation group (n=30) and non-extubation group (n=29). Age, cause of disease, duration of diseases (time from onset to extubation), duration of tracheostomy, total score and scores of functional mobility and language in Coma Recovery Scale-Revised (CRS-R), airway clearance by coughing, amount of expectation (evaluated by bronchofiberscopy), laryngeal edema and tracheal stenosis were analyzed to assess their relationships with tracheostomy decannulation. Results There were no statistical differences in age, gender, cause of disease, duration of diseases and average duration of tracheal intubation between the 2 groups. The extubation group had significantly higher total score of CRS-R, larger proportions of those with the score of functional mobility ≥3 and that of language ≥1, better airway clearance by coughing, milder laryngeal edema, lower proportion of residual expectation grade ≤l, and lower incidence of tracheal stenosis when compared with the non-exubation group (all P < 0.05). Logistic regression analysis showed that tracheal obstruction (P=0.001), abnormal salivary secretion (P=0.001) and CRSR-R score (P=0.036) were significant factors influencing extubation. Conclusion Tracheostomy decannulation is closely related to duration of disease, conscious status, cough reaction, laryngeal edema, amount of phlegm, and airway stenosis

Keywords

• disorders of consciousness
• tracheostomy
• decannulation
• influencing factors